FAIR CREDIT REPORTING ACT
AUTHORIZATION FORM
During the application process and at any time during the tenure of my employment with
American University, I hereby authorize a third party agency on behalf of American
University to procure a consumer report (known as an investigative report in California) which I
understand may include information regarding my credit worthiness, credit standing, credit
capacity, character, general reputation, personal characteristics, or mode of living. The
information requested may include, but not be limited to: verification of identification and/or
Social Security number; checks of criminal history, if any; verification of employment, education,
credentials or licenses, and credit history. Any information contained in such reports may be
taken into consideration in evaluating my suitability for employment, promotion, reclassification,
transfer or retention as an employee. This report may be compiled with information from credit
bureaus, courts record repositories, departments of motor vehicles, past or present employers
and educational institutions, governmental occupational licensing or registration entities, business
or personal references, and any other sources required to verify information that I have
voluntarily supplied. I understand that I may request a complete and accurate disclosure of the
nature and scope of the background verification, to the extent such investigation includes
information bearing on my character, general reputation, personal characteristics or mode of
living.
By signing below, I authorize without reservation any party contacted to furnish any or all
of the above mentioned information. I further agree that American University may obtain and
receive consumer reports to be used in connection with my application for employment
promotion, reclassification, transfer or retention at American University.
Date ____________
________________________
Applicant/Employee Signature
__________________________________
Applicant Name (First, Middle, Last)
______________________ __
Social Security Number
__________________________________
Permanent Street Address
________________________
Date of Birth
___________________________________
City, State, Zip
FAIR CREDIT REPORTING ACT
BACKGROUND VERIFICATION DISCLOSURE
As part of the employment process, American University will obtain an investigative
consumer report. The investigative consumer report may include information regarding
your creditworthiness, credit standing, credit capacity, character, general reputation,
personal characteristics and mode of living. The information requested may include, but
not be limited to: verification of identification and/or Social Security number; checks of
criminal history; checks of driving record; verification of employment, education,
credentials or licenses held by you; and credit history. Any information contained in such
reports may be taken into consideration in evaluating your suitability for employment,
promotion, reclassification, transfer or retention as an employee.
The following Consumer Reporting Agency is used to prepare the report:
US Investigations Services, Inc. (USIS)
LexisNexis Risk Solutions, Inc.
Automatic Data Processing, Inc. (ADP)
And any other records database or third party agency
I acknowledge that American University has with this form provided me a
summary of my rights under the Fair Credit Reporting Act in a form issued by the
Federal Trade Commission and entitled “Summary of Your Rights Under the Fair Credit
Reporting Act” located at
http://www.ftc.gov/bcp/edu/pubs/consumer/credit/cre35.pdf
I have read this form and understand my rights, and I have been provided a copy
of “A Summary of Your Rights Under the Fair Credit Reporting Act.”
Printed Name: _____________________________
Signature: _____________________________ Date: ______________
Para informacion en espanol, visite www.ftc.gov/credit o escribe a la FTC Consumer
Response Center, Room 130-A 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.
A Summary of Your Rights Under the Fair Credit Reporting Act
The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy
of information in the files of consumer reporting agencies. There are many types of consumer
reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell
information about check writing histories, medical records, and rental history records). Here is a
summary of your major rights under the FCRA. For more information, including information
about additional rights, go to www.ftc.gov/credit or write to: Consumer Response Center,
Room 130-A, Federal Trade Commission, 600 Pennsylvania Ave. N.W., Washington, D.C.
20580.
You must be told if information in your file has been used against you. Anyone who
uses a credit report or another type of consumer report to deny your application for credit,
insurance, or employment – or to take another adverse action against you – must tell you, and must
give you the name, address, and phone number of the agency that provided the information.
●
You have the right to know what is in your file. You may request and obtain all
the information about you in the files of a consumer reporting agency (your “file disclosure”). You
will be required to provide proper identification, which may include your Social Security number.
In many cases, the disclosure will be free. You are entitled to a free file disclosure if:
a person has taken adverse action against you because of information in your credit report;
you are the victim of identity theft and place a fraud alert in your file;
your file contains inaccurate information as a result of fraud;
you are on public assistance;
you are unemployed but expect to apply for employment within 60 days.
In addition, by September 2005 all consumers will be entitled to one free disclosure every 12
months upon request from each nationwide credit bureau and from nationwide specialty
consumer reporting agencies. See www.ftc.gov/credit for additional information.
You have the right to ask for a credit score. Credit scores are numerical summaries of
your credit-worthiness based on information from credit bureaus. You may request a credit score
from consumer reporting agencies that create scores or distribute scores used in residential real
property loans, but you will have to pay for it. In some mortgage transactions, you will receive
credit score information for free from the mortgage lender.
You have the right to dispute incomplete or inaccurate information. If you identify
information in your file that is incomplete or inaccurate, and report it to the consumer reporting
agency, the agency must investigate unless your dispute is frivolous. See www.ftc.gov/credit for an
explanation of dispute procedures.
Consumer reporting agencies must correct or delete inaccurate, incomplete, or
unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or
corrected, usually within 30 days. However, a consumer reporting agency may continue to report
information it has verified as accurate.
Consumer reporting agencies may not report outdated negative information. In most
cases, a consumer reporting agency may not report negative information that is more than seven
years old, or bankruptcies that are more than 10 years old.
Access to your file is limited. A consumer reporting agency may provide information about
you only to people with a valid need --usually to consider an application with a creditor, insurer,
employer, landlord, or other business. The FCRA specifies those with a valid need for access.
You must give your consent for reports to be provided to employers. A consumer
reporting agency may not give out information about you to your employer, or a potential employer,
without your written consent given to the employer. Written consent generally is not required in the
trucking industry. For more information, go to www.ftc.gov/credit.
You may limit “prescreened” offers of credit and insurance you get based on
information in your credit report. Unsolicited “prescreened” offers for credit and insurance must
include a toll-free phone number you can call if you choose to remove your name and address from
the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-5OPTOUT (1-888-567-8688).
You may seek damages from violators. If a consumer reporting agency, or, in some cases,
a user of consumer reports or a furnisher of information to a consumer reporting agency violates the
FCRA, you may be able to sue in state or federal court.
Identity theft victims and active duty military personnel have additional rights. For
more information, visit www.ftc.gov/credit.
States may enforce the FCRA, and many states have their own consumer reporting laws. In
some cases, you may have more rights under state law. For more information, contact your
state or local consumer protection agency or your state Attorney General. Federal enforcers
are:
TYPE OF BUSINESS:
CONTACT:
Consumer reporting agencies, creditors and others not listed below
Federal Trade Commission: Consumer Response Center -FCRA
Washington, DC 20580 1-877-382-4357
Office of the Comptroller of the Currency Compliance Management,
Mail Stop 6-6 Washington, DC 20219 800-613-6743
National banks, federal branches/agencies of foreign banks (word
"National" or initials "N.A." appear in or after bank's name)
Federal Reserve System member banks (except national banks, and
federal branches/agencies of foreign banks)
Federal Reserve Consumer Help (FRCH) P O Box 1200 Minneapolis,
MN 55480 Telephone: 888-851-1920 Website Address:
www.federalreserveconsumerhelp.gov Email Address:
ConsumerHelp@FederalReserve.gov
Savings associations and federally chartered savings banks (word
"Federal" or initials "F.S.B." appear in federal institution's name)
Office of Thrift Supervision Consumer Complaints Washington, DC
20552 800-842-6929
Federal credit unions (words "Federal Credit Union" appear in
institution's name)
National Credit Union Administration 1775 Duke Street Alexandria,
VA 22314 703-519-4600
State-chartered banks that are not members of the Federal Reserve
System
Federal Deposit Insurance Corporation Consumer Response Center,
2345 Grand Avenue, Suite 100 Kansas City, Missouri 64108-2638
1-877-275-3342
Department of Transportation , Office of Financial Management
Washington, DC 20590 202-366-1306
Department of Agriculture , Office of Deputy Administration -GIPSA
Washington, DC 20205 202-720-7051
Air, surface, or rail common carriers regulated by former Civil
Aeronautics Board or Interstate Commerce Commission
Activities subject to the Packers and Stockyards Act, 1921